Gundersen Health System, USA
Pat Tadel is a Senior Faculty/Consultant with Respecting Choices® in La Crosse, WI. She has over 18 years of experience in hospice and palliative care. She holds a post-doctoral certificate in Medical Ethics and clinical roles have included hospice case management, leadership, and administration. She is a current member of the Ethics Council for NHPCO, ELNEC trainer, and frequent national speaker on issues related to facilitation, bioethics mediation, and end of life ethics. Her commitment to engagement in the patient narrative is evident in ongoing work with special populations, including veterans at end of life, and access for underserved populations.
Working in the patient narrative has become a familiar term, used as part of the common language in the context of caring for patients. To do so encompasses sharing conversation that allows exploration of the entire patient experience as it relates to health and illness. However, the complexity of engaging in conversations about life-altering disease trajectories, potential outcomes from treatment, and end-of-life decisions is a learned practice. To stand steady with conflict, allowing for expression of grief, loss, anger, and frustration, yet remaining fully present, maintaining neutrality, and actively listening continue to be challenging concepts in practice. To do so is integral to collaborative practice and essential to effective engagement. A literature review identified key elements of intentional interactions which lead to significant opportunities to “wander more fully” in the patient narrative. Case studies used in discussion will demonstrate how patient/clinician encounters, such as end-of-life discussions; afford the interdisciplinary team members purposeful engagement with patients. Application of these principles will support clinicians in real world situations to delve more deeply into the patient experience. Such exploration lays the foundation for assuring goals of care are aligned with patient’s individual goals and values. Cases also demonstrate how the use of symbols by patients can be understood to assist in dialogue related to expressions of illness or tasks of dying. When directed and focused, intentional facilitation occurs, the patient’s unique holistic needs and values are identified and goals of care can be clarified. Practice implications are presented using research and clinical applications.
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